Author + information
- Miklos Rohla,
- Ioannis Tentzeris,
- Rudolf Jarai,
- Matthias Freynhofer,
- Serdar Farhan,
- Thomas Weiss,
- Johann Wojta and
- Kurt Huber
The role of bivalirudin monotherapy in patients undergoing percutaneous coronary intervention (PCI) has been studied extensively in randomized trials, although „real-world” clinical data are scarce.
In a retrospective analysis antithrombotic therapy and baseline variables were evaluated in 1,201 consecutive patients admitted with an acute coronary syndrome (ACS) and referred for PCI + stent implantation. Long-term all-cause mortality was compared between patients receiving peri-interventional anticoagulation with bivalirudin alone, heparin alone, or heparin + glycoprotein IIb/IIIa inhibitors (GPIs), respectively. The mean follow up was 58 ± 27 months.
From 1,201 consecutive patients undergoing PCI, 127 (10.6 %) patients received bivalirudin alone, 664 (55.3 %) patients heparin alone and 410 (34.1 %) patients heparin + GPIs. Out of a series of baseline variables the following were significantly different between groups: Age, gender, current smoking, peripheral vascular disease, renal failure, presence of atrial fibrillation, tumor anamnesis and baseline hemoglobin, respectively. In the cox proportional-hazards model peri-interventional anticoagulation with bivalirudin, as compared to heparin + GPIs, resulted in similar rates of all-cause death (HR 0.61, 95 % CI 0.33 to 1.14, p=0.12). However, anticoagulation with bivalirudin alone, as compared to heparin alone, resulted in significantly lower rates in all-cause mortality (HR 0.50, 95 % CI 0.27 to 0.9, p=0.02).
In this single-center series of 1,201 consecutive “real world” patients undergoing PCI + coronary stenting, the use of bivalirudin, as compared to heparin + GPIs, was associated with comparable long-term all-cause mortality. However, the use of bivalirudin was superior to heparin alone with respect to all-cause death thus confirming the dominant role of bivalirudin monotherapy as anticoagulant strategy in ACS patients referred for PCI + stenting in a “real world” setting.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Percutaneous Coronary Intervention for AMI: Predictors of Outcome
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1216-207
- 2013 American College of Cardiology Foundation